目的 探讨血清Toll样受体4（TLR4）/核转录因子-κB（NF-κB）信号通路因子水平与注射用丹参多酚酸治疗急性缺血性脑卒中疗效的关系，并探讨TLR4和NF-κB预测注射用丹参多酚酸治疗效果的应用价值。方法 前瞻性纳入2017年5月—2020年4月安阳市第六人民医院收治的急性缺血性脑卒中患者500例为研究对象，所有患者入院后予以吸氧、抗感染、降颅压等常规对症治疗，同时给予注射用丹参多酚酸0.13 g溶于0.9%氯化钠注射液250 mL中静脉滴注，滴速应≤40滴/min，1次/d；连续治疗2周。治疗结束，参照相关标准评估患者疗效，根据疗效将患者分为有效组（n=452）和无效组（n=48）；检测患者治疗前、治疗2周后血清TLR4、NF-κB水平，采集患者基线资料，采用Logistic回归分析血清TLR4、NF-κB水平与注射用丹参多酚酸治疗急性缺血性脑卒中疗效的关系，绘制受试者工作曲线（ROC），并计算曲线下面积（AUC）值，以检验血清TLR4、NF-κB水平预测注射用丹参多酚酸治疗缺血性脑卒中无效风险价值。结果 500例急性缺血性脑卒中患者经注射用丹参多酚酸治疗2周后血清TLR4、NF-κB水平较治疗前显著降低（P<0.05）；疗效评估结果显示，500例急性缺血性脑卒中患者经注射用丹参多酚酸治疗后有效452例，总有效率为90.4%，无效48例，无效率为9.6%；无效组治疗后血清抑素C（Cys C）、TLR4、NF-κB水平均高于有效组（P<0.05）；经Logistic回归结果显示，Cys C、TLR4、NF-κB异常表达可能与急性缺血性脑卒中患者应用注射用丹参多酚酸治疗无效有关，3者过表达可能是急性缺血性脑卒中患者应用注射用丹参多酚酸治疗无效的风险因子（OR>1，P<0.05）；绘制ROC曲线发现，血清TLR4、NF-κB单一及联合预测注射用丹参多酚酸治疗急性缺血性脑卒中无效风险的AUC>0.80，有一定预测价值，且在二者cut-off值分别取3.955、121.103 ng/mL时，预测价值最佳。结论 部分急性缺血性脑卒中患者经注射用丹参多酚酸治疗无效，可能与患者血清TLR4、NF-κB过表达有关，考虑可将TLR4、NF-κB作为辅助评估急性缺血性脑卒中患者应用注射用丹参多酚酸治疗无效风险的重要指标。

Objective To investigate the relationship between serum factors level of toll like receptor 4 (TLR4)/nuclear transcription factor-κB(NF-κB) signal pathway and the efficacy of Salvianolic Acids for Injection in treatment of acute ischemic stroke, and to explore application value of TLR4 and NF-κB predicting the therapeutic effect of Salvianolic Acids for Injection. Methods Total 500 patients with acute ischemic stroke treated in Anyang Sixth People's Hospital from May 2017 to April 2020 were prospectively included. After admission, all patients were given routine symptomatic treatment such as oxygen inhalation, anti infection and intracranial pressure reduction. At the same time, 0.13 g of Salvianolic Acids for Injection was injected intravenously in 250 mL of 0.9% sodium chloride injection, and the drip rate should be ≤ 40 drops/min, once a day, continuous treatment for 2 weeks. At the end of treatment, the efficacy of the patients was evaluated according to relevant standards. According to the efficacy, the patients were divided into effective group (n=452) and ineffective group (n=48). Serum TLR4 and NF-κB were measured before and two weeks after treatment. The baseline data of patients were collected, and the relationship between the level of serum TLR4 and NF-κB and the efficacy of Salvianolic Acids for Injection in treatment of acute ischemic stroke the serum TLR4 and NF-κB were analyzed by logistic regression. The subject working curve (ROC) was drawn, and the area under the curve (AUC) was calculated to test serum TLR4 and NF-κB level predicts the ineffective risk value of Salvianolic Acids for Injection in treatment of acute ischemic stroke. Results After treatment with Salvianolic Acids for Injection for two weeks, the level of TLR4 and NF-κB in serum of 500 patients were significantly lower than that before treatment (P<0.05). The results of curative effect evaluation showed that after treated with Salvianolic Acids for Injection, there were 452 cases were effective, the total effective rate was 90.4%, and 48 cases were ineffective, and the ineffective rate was 9.6%. In the ineffective group, the level of serum cystatin C (Cys C), TLR4, NF-κB was higher than that in the effective group (P<0.05). Logistic regression showed that the abnormal expression of Cys C, TLR4 and NF-κB may be related to the ineffective treatment of Salvianolic Acids for Injection in patients with acute ischemic stroke. The overexpression of the three factors may be a risk factor for the ineffective treatment of Salvianolic Acids for Injection in patients with acute ischemic stroke (OR > 1, P<0.05). The ROC curve showed that the AUC of is > 0.80 when serum TLR4 and NF-κB were used single and combined to predict the ineffective risk of Salvianolic Acids for Injection in treatment of acute ischemic stroke, which has a certain predictive value, and the predictive value is the best when the cut-off values of the two are 3.955 and 121.103 ng/mL respectively. Conclusion Salvianolic Acids for Injection is ineffective in some patients with acute ischemic stroke, which may be related to serum TLR4 and NF-κB is related to overexpression. It is considered that TLR4 and NF-κB can be used in the future is an important index to assist in evaluating the risk of ineffective treatment with Salvianolic Acids for Injection in patients with acute ischemic stroke.

R971